Provider Demographics
NPI:1861467391
Name:CRYSTAL CITY PHYSICAL THERAPY, RLLP
Entity Type:Organization
Organization Name:CRYSTAL CITY PHYSICAL THERAPY, RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-936-6657
Mailing Address - Street 1:123 CONHOCTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2911
Mailing Address - Country:US
Mailing Address - Phone:607-936-6657
Mailing Address - Fax:607-936-6747
Practice Address - Street 1:123 CONHOCTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2911
Practice Address - Country:US
Practice Address - Phone:607-936-6657
Practice Address - Fax:607-936-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0918Medicare ID - Type UnspecifiedGROUP MDCR ID